Remote Insurance & Credentialing Specialist

GoLean Health; Iloilo City; On-site; PHP 431,000 - 517,000; Part time

Job summary

GoLean Health is seeking a Back-Office Insurance & Prior Authorization Virtual Medical Assistant to support a US nonprofit behavioral health organization. This remote role focuses on insurance verification, authorizations, enrollment, and back-office processes to move patients toward care.

The candidate will handle eligibility checks, documentation, and patient follow-up across commercial plans and Medicaid, while coordinating with front-desk VMA and providers.

Qualifications

• Previous healthcare experience with substantial responsibility for insurance verification and prior authorizations.
• Experience with US commercial insurance plans, Medicaid, or both.
• Experience contacting insurance companies and using payer portals.
• Strong understanding of healthcare eligibility and authorization workflows.
• Experience using an EHR or practice-management system.
• Strong administrative documentation and data-entry skills.
• High attention to detail and accuracy.
• Strong follow-up, organization, and task-management skills.
• Professional verbal and written English communication.
• Ability to work independently and manage multiple pending cases.
• Strong understanding of HIPAA and patient confidentiality requirements.
• Reliable attendance and punctuality.

Responsibilities

• Verify patient eligibility and benefits with commercial insurance plans and Medicaid.
• Review payer information and document verification results in clinic systems.
• Identify insurance requirements or missing information that could block enrollment.
• Initiate and process prior authorization requests.
• Communicate with insurance representatives and use payer portals for requirements and status.
• Track pending authorization requests through approval or denial.
• Assess eligibility for nonprofit financial assistance or reduced-cost programs.
• Follow up with patients for missing forms or information.
• Maintain documentation of eligibility status and next steps.
• Set up patient profiles and collect required forms for intake.
• Review intake documents for completeness and follow up for signatures or details.
• Coordinate with front-desk VMA and confirm steps to scheduling.
• Assist with provider credentialing and payer enrollment.
• Prepare patient charts and ensure completeness before appointments.
• Document and resolve missing or inconsistent information.
• Manage backlog and prioritize cases.
• Provide cross-functional administrative support.
• Document SOPs and update processes as needed.
• Identify bottlenecks and suggest improved workflows.

Skills

Insurance Verification

Prior Authorization

EHR

HIPAA

English Communication

Remote Work

Tools

AdvancedMD

Microsoft Teams

Payer Portals

VPN

Job description

GoLean Health is seeking a Back-Office Insurance & Prior Authorization Virtual Medical Assistant to support a US nonprofit behavioral health organization. This remote role focuses on insurance verification, authorizations, enrollment, and back-office processes to move patients toward care.

The candidate will handle eligibility checks, documentation, and patient follow-up across commercial plans and Medicaid, while coordinating with front-desk VMA and providers.